Which Patient Are You?

 I am back to the comfortable zone of writing a blog post after a while. Do not expect me to be regular when the boards are coming, (it’s this January).

The other day when I was attending to an old lady, this is somewhere in Naxal, in a small clinic for patients who seek medical attention for free. I was taking her history as usual. Later on, when a board certified doctor examined her and gave her medications for the illness, she left the clinic as usual but I was curious to know about how she felt about the interaction with the doctor.

So in the next subsequent minutes, I exchanged a few words of reassurance to her and she just smiled and gave me blessing to become a better doctor in the future. The story ends there but then I started to realize that reassuring a patient is very essential from the treatment perspective.

So in the next few hours, I reassured the next ten patients who were in the list to get diagnosed and even when the senior doctor already gave them a quick reassurance, they liked the way I tried to explain the same fact again, this time taking more of their time and mine to do so. In my quest to find the solution between the endless distance between doctors and patients, I have come to analyze patients as well. The classification is as follows:

The “Grumpy kind”: These people don’t publicly share their dislike for the way the doctor’s handled them. They go home, complain about how the doctor handled his/her case. These people are opportunistic when it comes to expressing their dislike towards doctors.

The” Violent kind”: Now, we have had heard stories about doctors getting beaten by patients. But let’s take a look at what I have to say about this: Doctor’s are responsible citizens who aim to protect and care for the sick and needy. Mistakes are not preventable. There are ways of handling situations where mistakes are unacceptable but violence is not one of them. I will have to say that patients like these are idiotic in nature. Either they don’t know terms like ” sue ” and ” law” or its the natural spontaneity of these people to act in the way that they just did.

The “I don’t believe in doctor’s kind”: These people believe in supernatural power of healing and have absolute no intention of visiting the doctor at any cost.  Either coming to the doctor is the last resort or things seem unfavorable in the supernatural department.

If you are a patient and if you want satisfaction during a visit to the doctors clinic, write to healthnepal11(dot)gmail. Share us your stories and help us make better doctors for the future. Health Nepal Foundation is keen to decrease the gap between the patients and doctors and we want to improve the health care system in Nepal.

Patients Grief Becomes My Grief!

There is no paragraph, no sentence, and no word that actually teaches you to avoid such circumstances. I have watched many movies, teachers telling med students not to get emotionally attached to their patient’s grief. In reality they hardly talk on this matter and they rarely share their experiences.

I am a human being, a sub set of the human race which has considerable estrogen in my system that fuels emotions.  Minor trivial things matters, although I filter most of them but some stick to the very end of my heart. This case for instance, was very much my first.

It all started when we finished learning the examination of the cardiovascular system. I decided to go to the Cardiology ward where I was scanning reports for positive findings. He was just sitting in a propped up position. This old man, in his mid 60’s suffers from left-sided heart failure due to a narrow valve (mitral stenosis).

Whenever you start a conversation with a patient, you eventually want to examine him/her immediately afterwards. So he agreed to show his precordial area (the area of the chest, beneath which the heart is located). I actually did not need to palpate his heart because his cardiac pulsations where heaving in nature. You could see the man’s heart doing its job from the skin. On palpation, the heart thrilled. On auscultation, you could hear pan systolic murmurs (added sounds /abnormal heart sounds).

I thanked him for his co-operation and bid good-bye for the day. The next day, I went to him with some of my other friends. He spontaneously started to cry. We asked him the reason for his sadness apart from the pain that he feels with the diseased heart. He wants to live longer for his six daughters. Three of them are still unmarried; he is worried about their future. He cries some more. I tried my best to console him; I was experiencing his pain as well. Deep down under I was hoping for a cure, hoping that he will get well in time to get his daughters married. But all that shattered when the Chief Cardiologist declared “he is an inoperable case, we need to counsel him “. End of the round check up.

It takes me a while to formulate and forget things that happens to the patients around the ward. He was not going to live longer and his grief was justifiable. You don’t see much men cry but when they do its more complicated.

I felt like going back to the chief cardiologist, may be if I raised my voice, he would consider doing the operation. But I am a “nobody” right now and emotions have no role in medical science, I kept reminding myself. It’s not movie where a med student gets determined to do something for her patient that cried for his life. In reality people die and nobody teaches you to deal with patient’s grief. You have to deal it on your own.